What is the treatment for a patient with a testicular ultrasound (u/s) showing a trace right hydrocele and a 6mm cyst in the right epididymal head?

From the Guidelines

For a patient with a testicular ultrasound showing a trace right hydrocele and a 6mm cyst in the right epididymal head, observation is typically the recommended approach as both findings are generally benign and asymptomatic. No specific treatment is necessary unless the patient is experiencing pain or discomfort. A trace hydrocele (small collection of fluid around the testicle) and small epididymal cysts (also called spermatoceles) under 1cm are common incidental findings that rarely require intervention 1. If the patient develops pain, over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) may help manage discomfort. Scrotal support or wearing supportive underwear can also provide relief if needed. Follow-up ultrasound in 6-12 months may be recommended to ensure stability of the cyst. Surgical intervention (hydrocelectomy for the hydrocele or cyst excision) would only be considered if the patient develops significant symptoms or if the lesions substantially increase in size. These conditions are benign and do not affect fertility or pose cancer risks, which helps explain why conservative management is appropriate, as also suggested by recent guidelines on testicular cancer 1. It's worth noting that testicular ultrasound is highly sensitive for detecting intrascrotal masses and can accurately differentiate between intratesticular and extratesticular processes 1, but in this case, the findings do not indicate a need for immediate intervention. The patient should be informed about the benign nature of these findings and the low risk of malignancy, as indicated by the European Association of Urology guidelines on testicular cancer 1. Overall, the focus should be on managing any symptoms that may arise and monitoring the condition with follow-up ultrasounds, rather than proceeding with surgical intervention unless absolutely necessary.

From the Research

Treatment for Testicular Hydrocele and Epididymal Cyst

• The treatment for a patient with a testicular ultrasound showing a trace right hydrocele and a 6mm cyst in the right epididymal head depends on the severity of symptoms and patient preference.
• For hydroceles, treatment options include:
  • Conservative treatment
  • Fluid aspiration
  • Hydrocelectomy (surgical removal of the hydrocele) 2, 3
  • Minimally invasive treatment, such as individualized minimally invasive treatment for adult testicular hydrocele 4
  • Aspiration and sclerotherapy (AS) with doxycycline or 100% alcohol 5, 6
• For epididymal cysts, treatment options include:
  • Aspiration and sclerotherapy (AS) with 100% alcohol 6
  • Surgical removal of the cyst
• The choice of treatment should be based on the patient's individual needs and medical history, as well as the size and location of the hydrocele and epididymal cyst.

Considerations for Treatment

• The size of the hydrocele and epididymal cyst can influence the choice of treatment, with larger cysts potentially requiring surgical removal.
• Patient age and overall health can also impact the choice of treatment, with younger patients potentially being more likely to experience persistence of symptoms after treatment 6.
• The risk of complications, such as hematoma, infection, and chronic pain, should be carefully considered when choosing a treatment option 4, 3, 5.